A Medicare Local has told its GPs to restrict the number of disadvantaged patients they refer to its ATAPS program in an attempt to avert a budget blow-out.
Greater Metro South Brisbane Medicare Local wrote to doctors last month [PDF], telling them they could only make a maximum of three referrals over a six month period to the Access To Psychological Services program.
The move has raised questions about the adequacy of ATAPS funding and whether GPs should be left with the responsibility of deciding which patients should be given access to mental health care.
The program was originally set up in 2001 to ensure vulnerable and hard-to-reach patients — particularly those who cannot afford mainstream Medicare services — have access to counselling from psychologists. But unlike Medicare, the budget for ATAPS, which is now administered through the network of Medicare Locals, is capped.
Greater Metro South Brisbane's letter to GPs said the number of GP referrals to its ATAPS program had tripled, resulting in its decision to introduce the referral cap.
"To ensure the program achieves equitable service availability for both clients and providers, a decision has been made to limit the number of tier one (General) ATAPS referrals to three referrals per GP (effective 1 January 2013)," it said.
The letter, written by acting CEO John Torpy and leaked by the Better Access Alliance campaign group, said the decision would be reviewed in March.
The cap applies only to tier one patients and will not affect referrals for patients at high risk of suicide, perinatal depression or Indigenous patients.
The letter also stressed the Medicare Local would consider requests from GPs to increase the number of referrals they can make to ATAPS services on a "case-by-case basis".
A spokesman for the Medicare Local said the increased demand for ATAPS services was partly a result of greater awareness among local GPs. He stressed that given the fixed budget for ATAPS, most of the previous divisions that had run the program had also had been forced to manage demand.
He said in some cases divisions had shut down the program until new funding became available.
In 2011, the Federal Government defended its controversial decision to cut almost $580 million from the Better Access program by pointing to its decision to double funding for ATAPS — an increase in funding of $206 million over five years.
However almost half of that new money — some $100 million — will only be handed over to Medicare Locals in a two year period after the middle of 2014.
The Better Access Alliance, the campaign group calling on the government to reverse the Better Access cuts, said in its blog: "The capped funding model [for ATAPS] means that GPs are no longer able to refer on the basis of the mental health needs of the patient, but rather, on the basis of funding limitations...
"[The] ability to provide psychological care to people with a mental health condition is being taken away from our mental health professionals and put in the hands of managers who are detached from any contact with the patient."
A 2011 Australian National Audit Office report said the former divisions of general practice — the organisations that originally ran ATAPS — were forced to make "demand management" decisions to keep costs within their ATAPS budgets.
They included the use of cheaper group therapy, the introduction of waiting lists and limiting the number of psychological sessions offered to patients. A number of divisions had also charged some patients gap fees.